9215 SW EDGEWOOD STREET tD
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"- 9215 SW EDGhWOOD STREET ~
CITY OF TIGARD
DEVELOPMENT SERVICES PERMIT
PERMIT
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 PF RM I T L7SU 6/97 t
rTTE T55UCD: 0�:/��F�/97
PARCEL_- 'c�:S l 02DC_.0040,
[TE ADDRES�, . . t 0`3, '15 SW EDGEsWOOD S1
,71_IBDIVr91ON. . . . : EDGE=WOOD ZnNINO: R---4. 5
31_OCK. . . . . . . . . . . L07. . . . . . . . . . . . . : 18
',i._nPm:) OF WORK. . :ALT GARBAGE DISPnSAI_.r. : I� MOBTLE HOME SPACES. : 0
'-YPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 1
`ICCUPANCY GRP. . : R3 FI-OOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . . 0
''!TORIES. . . . . . . . : 0 WATER HFATEERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
F"IXTURF_'!; _.____.__... __.__..._. I...AUNDRY TRAYS. . . . . : 11) SF PAIN DRAINS. . . . . : 0
'aTNKS. . . . . . . . . . : 0 URINALS. . . . . . . . .. . . .. 0 GRE=ASE= TRAPS. . . . . . . e 0
.AVATORTES. . . . . : 0 OTHER FT.XTURE'S. . . . : 0
TUB/Sl-LOWERS. . . . : 0 SEWER LINE (ft) . . . : 0
'MATER CLOSETS. , : 0 WATF R LINE (ft ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN ( ft) . . . : 0
�2emarlts : T.nstal lat ion of residential bark --flc,w device
lwner —_..----_--__—_—________________________.__________..___ FEES
!3OP BUNGER type amount by date recpt
>='15 SW EEDGEWOOD PRMT $ 15. 00 DRA 02/26/97 97-290865
5F'CT $ 0. 77) DRA 0r'/2f-",/97 97--2908675
I I(SAID OR 97223
Dhone #:
I'RYON CREEK LANDSCAPE INC
11400 SW NORTH DAKOTA ST
IGARD OR 97223
!=Bone #: $ 1.5. '75 TCITAI.-
Re #. . . 110525
RE(:UIPED TN9PFr.TTnN9 --
This pereit A issued subject to the regulations contained in the plater- Line Insp
Tigard Municipal Code, State of pre. Specialty Codes and all other Water- service In
applicable laws. All work will be done in accordance with RP/Backflow Prev _
app-nved plans. This perait will expire if work is not started Fiiia.l Inspection
within 180 days of issuance, or if work is suspended for Bore
than 180 days.
a r•
In i t t e e � � .
Irs�.rad T7 .
y
�_- C;a 1 1 for, inspection 839-4175
TY OF TIGARD Plumbing Application Rec19v
;125 SW HALL, BLVD. Commercial and Residential Cate Recd 'L 77—
—
,GARD, OR 97223 Cale:o P E —
503) 639-4171 r.ate fo csr
PPfrnil: 4rr��;� a,
Pant or Type Related Si,vR s
Incomplete or illegible applications will not be accepted called —
Na re of CevelopmenUP'olect FIXTURES (Individual)~� QTY PRICE AMT
Job �pJ 3ulN4C� Sink _ 900 l
Address S"Pel Addressi Suite Lavatory 900
���------4----41 J 50 4Et•)�✓J 1 �� rub Or �ubi:ihdwvr���rn0 ~--
=' f 71y'state .:p ihawer Jmv 9 00
— -ri�� 1_1 1 Water Closet 300
game Water 00
Disnwasner 900
Owner %ta l n drgssSuite Garoage Disposal 9 00
Nashmq hlaclvne I 9 00
w,lv slate p Phone Floor Drain 2
�� goo
Name 3 9 00
900
Occupant -Mailing Addr ss Y✓\ Suite water Heater 9 OU
ad _` laundry Room Tray 9 C0
CitylSlate, Zip Phone Unnal
900
Name Clher Fixtures(Scer,ty) I 900
TRYoN 900
Contractor Mailing Address - Suite 900
'nor to issuanre, C,ty,State Zip Phone --- 9.00
applicant must � lI (t. ]Z Z%3 &/-z �y 9.00
provide an Oregon Const Cont Board Lic s Exp Date _ 9 o0
con(rac:ors Z ^ Z J _ ► 1 9.00
license Plumbing L e r� Exp.Daties Sewer• tst 100'
Wermatinn _ 30 00
or COT COT Business rax or Metros to Sewer•each additional 100' I 25 00
xp Cate _
aalabase) I - Neler Service• ist too- V JU UU
Name 1 - "rater Service•eacn additional "`1n' I 25 00
Architect Storm S Ram Cram. 1st 10p — 30 00
Orhlarirnq Addrc�i Suim te Storm S Rain Drain•each add f nal 100 25.00
__ I Mobile Homu Space 2500
Engineer c iy,_S ate Zip Phone -- l Commeraal Baa=ow prevention Cevrce or Anti- l 25 00
_ aclfutior Device _11`
oe.vcrtt New .; Addition C literation car 4esidential 9acitlow 3_eventic CencP' 5]0 Spv
;es derti
onal description o1 wcnr ^n•res Crnual f
Ary i rao or:ras:e N.'.Connec:ed:o a--xture I 9 q0
—'—`—
Catch 3asm 00
P.n,io.neo or existing-umo rg I 40 00
4 oer;hr
rg use .f L_ -- °oeaady Reduesteri'nsoecvons 4000
.ng or orocerty� ` Icer.hr
--- I Pain Crain smg:e'amity cweilirg 1 I JO :,0
.COSed use:f I Gfease Trans .... I I 91
.,ding or procerty
QUANTITY TOTAL I l
.ou Ca00mg moving ar reulac:ng any rlxtures Yes No I sar•etrc�r^sef c agram s-ecutr� f^ua�4t ' hal s >? I i—�4
I yes see tack of fortnt 'SUBTOTAL
---- -i
acxncw edge:ha: nave read:h s 3ppucaticn.!hat the information
's correct :hat f am tie owner or autnonzed agent of me owner and 5% SURCHARGE
"a:Gans sur^:Rea are - _cmcliance with Cregcn State Laws
gnsture of OwneriAgen, Date ( PLAN REVIEW 25% OF SUBTOTAL j
aecurm ynry '`mre ci-1 "i s
'!
tit P non►lame Phone I ' d5'75
'Min mum permit fee 5 J<5 ' 5", surcharge except;es dentiar Bacxtlow
Prevertion Cevrce +vaic.'h s 315- 5%surcharge
Costs plmapp doc 3195
%Kim VIPI.ETF_ AS APPRQPRIA ("F T PFZOJECT:
Fixtures to be capped. move_ d or replaced Qty-I
Sink
Lavatory
I
Tub or Tub/Shower Combination
Shower Only
Water Closet — ^�
Dishwasher _
j Garbage Disposal
Washing Machine _
Floor Drain 2"
Water Heater
Laundry Room Tray _
Urinal
Other Fixtures (Specify)
i
OMMENTS REGARDING ABOVE: